India

The Culture and History of India

The Indian culture began with nomadic tribes, and an urban culture slowly developed.  By 2500 BC large cities were established, with empires the size of others during that time period.  The religions of Buddhism and Jainism developed around 500 BC. The culture developed, with flourishing arts and literature, and trade with other empires became an important income for the country. By AD 319 Hinduism became the main religion, although North India was largely influenced Muslim by the 11th century.  The Portugese in 1498 and then the English in 1600 laid claim to India.  A British trading company ruled over India, and by the 19th century India was under British control.  Indian people desired independence and attempts began in 1885.  As India came close to independence, their country was becoming more divided between the Muslim North and the Hindu South, with violence between the two lasting for many years.  India now has a democratic congress, and the country is working at maintaining peace within the country.  Throughout this tumultuous history, the Indian culture has endured and the importance of religion has remained a prominent value for this culture.  The traditions, customs, arts and beliefs of these people have endured through the years to maintain their rich culture.

Values/Norms

The caste system is a central part of Indian society and it represents a hierarchical relationships within everything. It’s important to know your social order and to behave appropriately. The rich and powerful are at the top while the poorer are at the bottom (Order: priests, warriors, merchants/landowners, commoners/peasants/servants, street sweepers/latrine cleaners). Men are above women and the older are above the younger within the groups. The caste system ties into their Hindu beliefs that if someone lives a good life in their caste system, they will reincarnate into the next highest level and eventually reach freedom (nirvana). In general, people are glad to be subject to this system because they consider it a temporary stage in the grand scheme of life.

Children/families are reminded of their roles in society. Families still consider the birth of a male to be more of a blessing and they throw a celebration in his honor while a female child is less desired.  Often a women’s ability to bear boys directly affects her relationship with her husband and family. A woman who has many girls (and no boys) may be shunned or divorced.  Divorce is a rare occurence, however, because marriage is considered a lifelong commitment regardless of how well it is working. Children usually grow up to do what their parents did which correlates with the caste system. Families are central to the Indian culture. Many generations will live together in a house and care for each other. The oldest male is the leader in the house.

Beliefs/Attitudes

The three main religions of India are Hinduism (81.3%), Muslim (12%) and Christianity (2.3%). Because Hinduism is the overwhelming majority, this section will focus on its components. Hinduism is directly linked to the caste system, this religion combines the three-in-one god Brahman (the creator), Vishnu (the preserver) and Shiva (the destroyer). Karma is the law that governs what happens to you if you do good or bad. Each action, thought and decision has a consequence good or bad that determines your next life. Reincarnation will lead to a rebirth which could take you up or down in the caste system depending on your previous life. The four castes are Brahman (priest), Kshatriyas (warriors), vaisyas (merchants/famers), shudras (laborers) and then the untouchables. Nirvana is the goal of all Hindus to reach a god-like state and be free of the cycle of rebirth. The most popular path to salvation (moksha) is self-surrender to a personal god/goddess of Hinduism and devotion expressed through acts of worship, temple rituals and pilgrimages. Other paths include fulfilling the duties of one’s social position or identifying one’s self with Brahman through meditation.

Traditions: Although women have many more rights in India today, they still often succumb to arranged marriages. Many women are married under the age of 18. A dowry is also a popular and widely practiced tradition during marriage.  The women, although equal under law, are often treated inferiorly and according to society are expected to fulfill certain household roles.

Child marriage is not legal but is still practiced in some rural parts of India

Traditional Sari worn by Indian women

Indian names are often based on religion and caste.  They are given a birth name (based on their horoscope) and a family name. Naming conventions are a popular ceremony to officially mark the baby with a title. There are many regions and different methods of naming which influence how many names you have and what your official title becomes. Namaskar is a traditional greeting in India where you put the palms of your hands together and raise them to your chin.

The Tilak and Bindi are red dots applied to the forehead between the eyebrows. The Tilak is a ritual mark of concentration and worship and signifies the opening of the third spiritual eye while the Bindi signifies female energy and serves as protection for women and their husbands.

Festivals:

Diwali: Five day “festival of lights” which marks the beginning of the Hindu new year (usually October or November) and is celebrated by lighting lots of lamps, candles and fireworks and home decorations.

Rakhi: a festival symbolizing protection from evil through the love and affection of brotherhood (late August). Brothers and sisters dress in traditional clothing and there are many sweet dishes prepared.

Holi: the festival of colors is celebrated in the spring and symbolizes the victory of good over evil and is a time for farmers and rural peoples to be thankful for prosperity.

Communication Style/Language

There are hundreds of dialects within the traditional language of India, with Dravidian and Indo-Iravian being the two most common.  Most people are multilingual and are familiar with many dialects within the Indian language.

In regards to communication style, people from India seldom use “no” or negative word.  They don’t want to disappoint the person they are talking to, so instead they will say things such as, “it is unavailable” in order to avoid negative forms of words.  Due to the respect held for elders, when meeting a group of people the elder is greeted first.  When leaving, they always say goodbye to each person individually.  There are also a lot of boundaries set between men and women, and in more traditional cultures there aren’t handshakes between men and women.

Dress/Appearance

Traditional dhoti worn by Indian men

Indian clothing is very modest, especially woman’s clothing.  It must be below the knee and cover the shoulders.  Bare shoulders are considered a sign of immorality; for women it is suggested to attract unwanted attention from men.  Men traditionally wear a dhoti along with a kurta top, which is a loose fitting shirt.  Depending on the area, the dhoti can be worn different ways.  In some places, such as communities in Rajasthan, it is mandatory to wear the dhoti.  In other places it is often only worn by elders, politicians, and other important figures.

Traditionally, women wear a Sari and a blouse.  The Sari is most commonly worn wrapped around the waist with one end over the shoulder, baring the midriff.  It is thought that the traditional dhoti for men was where the Sari originated from.  Earlier in history, the type of thread used to make the Sari represented a woman’s amount of wealth and status.  Part of women clothing includes their make-up, Bindi.  Traditionally the Bindi is a red dot placed in the middle of the forehead.  The Bindi used to be representative of marital status, religion, age or ethnic affiliation but it is now used more as a decorative item.

Food/Feeding Habits

Indian food is influenced by Chinese and Mongolian.  The location and climate makes it possible to grow rice, green vegetables, and fruit.  The people are almost half vegetarian, but the meat-eaters tend to eat a lot of fish and pork.  Mustard oil is commonly used for frying and cooking.  Several spices are particular to this region including mustard seeds and paste, red and green chillies, a mixture called Paanch Phoran, which includes white cumin seeds, onion seeds, mustard seeds, fennel seeds, and fenugreek seeds.  Yogurt is often used as well as other dairy products in sweets.  Coconut, maize, and of course curry are also common.  Tea is drunk by many, especially a tasty blend of tea leaves with all the makings of a fine ginger snap cookie: cardamom, cloves, ginger, cinnamon with milk.  Often meals are partaken of on the floor or on short stools or cushions, without any silverware.  It is proper to use the right hand and only up to the second joint.  Flatbread such as naan is used as a kind of scoop.  Many Indian foods, traditions and spices, such as pepper are a mainstay and staple in homes around the world due to the Indian spice trade.

Time Consciousness


Time is fairly fluid and Asian Indians have been known to be the least time conscious people in all the world.  Tardiness is not as frowned upon as in the U.S..  Children and young adults have less free time due to jobs and necessity in helping out with family matters.  An attitude that things will happen when they will is very prevalent.

Relationships/Social Organization


India is a vast country with a large population that has been influenced for a long time by many people, needs, geography, and religions.  The social organization differs greatly between the rural and urban areas. Currently there is dichotomy over the issues of modernization and tradition. Religion and spirituality are intricately weaved into the culture and relationships.  Family is exceedingly important and males tend to be the breadwinners and heads of the house.  Marriages are legal at the age of 18 and are often arranged by the parents or professional matchmakers.  Once married, the wife moves into her in-laws home and falls under the instruction of her mother-in-law to be taught the duties of the house.  The Caste System is a well-known and recently weakened system involving many rules regarding marriage, relationships, vocation, socioeconomic status and treatment.

Mental Process/Learning

Education is very important in the Indian culture, second only to respect.  Originally, the highest caste (Brahmin) was for teachers and priests, which shows the emphasis this culture puts on education. However, education is based on financial capabilities, and poorer people who cannot afford education will not receive it. Because education is so important, some parents push children to exceed their abilities.  Some families come to the United States so that their children may receive an eductation.  Some children are pressured so much that they experience depression or other psychological problems.
There have been great advances made in education, with current successes in technology, science, literature and film.  The literacy rate has risen since the late 20th century, and union government has played a role in promoting education for girls, who have been underprivileged.  There are many private and church run schools.  The caste system still plays a factor in education, with reserved quotas in many universities and lower admission standards for members of higher castes and tribes.

Work Habits/Practices

A large majority of East Indians practice Hinduism, and this is assimilated into how they live their daily life.  In Hinduism, a person must fulfill their dharma, or moral duty, so that in the next life they may be born into a higher caste system, or, a better life.  This focus on religion carries over into work habits and practices, and many people consider their careers one more place to work hard to fulfill their dharma.  The caste system is also an important part of the Indian culture although it is weakened, and the caste a person is born into determines their position in society, which determines a person’s economic standing.  Agriculture is the country’s main employer, but it is no longer the largest contributor to the gross domestic product.  The industries that are growing the most presently are in trade, finance and other services.  Like other aspects of the Asian-Indian culture, traditional forms of work have slowly given way to globalization, although many rural areas, and some cities as well, are still practicing more traditional, self-sustaining labor and work practices.  Government plays a central role in the Asian-Indian economy.


Indian Culture Within the United States:

Demographics:

Total U.S. Asian Indian population 1,645,210
Native born citizens 24.6%
Growth Rate 53%
Mean age: 20-40 $0%
Most concentrated regions CaliforniaTexasNew YorkNew JerseyIllinois(All with populations over 60,000)
Language 73% = English
Avg household family size 3.383 people
% Married 89.2%
Mean Household income $83,820

EDUCATION & WORK:

High School Diploma 86.6%
Bachelor’s Degree or higher 63.9%
Women in Workforce 57%
Men in Workforce 71%
Poverty rate 9.8%

RELIGION

Hindu 83%
Muslim 14%
Other Religious Groups 3%

Within India:

HEALTH

% People using improved drinking-water sources 89%
% of routine EPI vaccines paid by government 100%
Immunizations:
DPT, corresponding vaccines: DPT1ß 83%  (1 yr olds)
TB 87%  (1 yr olds)
Polio 67%  (1 yr olds)
Measles 70%  (1 yr olds)
Hep B 21%  (1 yr olds)
Tetanus 86%  (Newborns)
% Children under 5 with suspected pneumonia taken to health care provider 69%
% receiving antibiotics 13%
% Children under 5 with diarrhea receiving oral  rehydration and continued feeding 33%
% Children under 5 with Malaria receiving anti-malarial drugs 8%

HIV/AIDS

Estimated number of people (all ages) living with HIV (2007) 2,400,000
% Young people who have comprehensive knowledge of HIV Male: 36%Female: 20%
Orphans (age 0-17) due to all causes (2007) 25000 (estimate)
Orphan school attendance ratio 72%
Contraceptive prevalence 56%

Health Care


DISCRIMINATION

In traditional Indian culture, the women have a submissive, dependent role as the housewives and depend on men as the breadwinners.   They face discrimination in many areas, for example: Indian women have less access to healthcare and education, crime against Indian women is a problem, there are still numerous deaths related to dowries, many female babies are aborted, and there are high rates of maternal morbidity.

There is much discrimination against the disabled in India.  Those with a physical disability are thought to have done something to deserve their misfortune – this follows along with the ideas of Karma and Dharma.  They just become another level of the caste system and they are treated according to where they fall along the spectrum.  Indians are reluctant to report when their family member has either a mental or physical disability because this just draws more attention and they believe it is a justified illness.

DIFFERENCES IN CULTURE

Many people live in tribal communities in India.  Tribes are bound by their need of natural resources, are often geographically isolated, and are ruled by kinship values. Traditionally, illness was believed to be the result of some evil and would only be able to be remedied by making sacrifices or jhar-phuk, exorcism.   Even a type of rice beer, handiya, is sometimes drunk or worshiped in an attempt to stave off unhappiness, illness, or suffering (Basu & Datta).

It’s important to know the major differences between India and the US because it can help everyone (including healthcare workers) to identify relevant disparities.  Most importantly is understanding that India has a caste system which labels everyone while the US strives to achieve equality among individuals.  Individuality is another important concept because India revolves more around a family structure and performing duties solely for the family.  The US focuses on the individual and setting and achieving goals for one’s personal gain. The US is very time-oriented and people are expected to show up on time for appointments but in India time is subjective and being late is much more acceptable.

Within Indian society, the roles of men and women are distinct. Women manage the home by keeping all finances, family, and social issues in order. Women are more passive in the Indian culture and men typically are the bread-winners and managers of issues requiring interaction with individuals in the community, e.g., health care. This type of behavior implies that men have a dominant and authoritative role because they are the primary point of contact with society. However these roles are beginning to change among educated Indians in the larger cities of India and among immigrants in progressive or permissive societies such as the United States. 

Modesty is highly valued among Indians and patients are decidedly more comfortable and secure with same-sex care providers. Also see women’s health, diet, and other relevant sections.

In an article about Indian health beliefs and end of life practices, Bhungalia and Kent explore the Indian system of medicine is known as Ayurveda, which means “knowledge of life.”  The Ayurvedic system has the body comprising three primary forces called dosha.  The state of equilibrium between the dosha is a state of health and an imbalance is disease.  The dosha represent characteristics derived from the five elements of space, air, fire, water and earth.  This form of medicine classifies people into one of the doshas, and this helps the physicians to treat them accordingly.  For example people with the dosha called Vata are thin and quick thinking with swift action.  If these people become imbalanced they become nervous, anxious, constipated and insomniac.  There are 1400 plants used in Ayurvedic medicine, most with few side effects.  These do not have resemble any instant pain relievers, antibiotics, or other western medicines.  This form of medicine focuses on finding the root cause of disease, and not causing new symptoms by suppressing current symptoms.  The Ayurvedic physician must study all contributions to the disease, including environment (Bhungalia & Kent, 2002).  While some of the ideas are similar to western medicine, such as finding the root cause of the disease, Ayurvedic medicine is a much more natural approach looking at the body in an almost spiritual way.

Indians also view end of life differently than a western perspective.  Many Hindu Indians prefer to die at home, and some return to India, especially to the sacred city of Varanasi, to die.  Therapeutic measures may be refused because many believe their suffering is a result of Karma and should be endured.  The dying person might want a lamp placed near their head, facing east, and chanting, praying, and incense are part of the process.  A dying person also has a large number of family around them.  When the patient has died, the family should be the only ones to touch the body.  The family may want the body transported home, with cremation as the preferential burial treatment.  It is believed the soul travels throughout the home for 12 days after death in Hinduism (Bhungalia & Kent, 2002).

HEALTH RISKS AND HIGH RISK BEHAVIORS

Health care in India is based hugely on context.  A study by Purdue University focuses on the issues that influence acquisition and availability of health care in rural India.  Over 70% of more than a billion people live in rural India.    This study calls much of rural India a “marginalized” population, which is defined as, “the mix of social, structural, cultural, economic, and political processes by means of which a group is ignored, trivialized, considered invisible and unheard, and/or perceived as the deficient ‘other’” (Basu & Dutta). This marginalization contributes to higher health risks by severely limiting access to health care and the ability to improve health and quality of life.  HIV/AIDS prevention is bound to education, poverty, socioeconomic status, caste, and gender, and those in rural India have little access to education and are plagued by the bonds of poverty.  If safety, hunger, and shelter are in danger of being compromised, these issues take precedence over health needs.

Specifically, due in part to poor nutrition, and also due to the vegetarian diet, Indians living in India may be at risk for protein malnutrion, beriberi or thiamine deficiency, pellagra or niacin.  Iron-deficient anemia can be a problem, and lathyrism.  Lathyrism is a disease caused by eating a certain type of plant that causes irreversible muscle weakness and paraplegia.  Diseases in India that are prevelant include: malaria, respiratory infections such as tuberculosis and pneumonia, hypertension and CVD, rheumatic heart disease, nutritional deficits and high risk behavior such as alcoholism and cigarette smoking.

CULTURAL TABOOS


Homosexuality has gradually become a more acceptable practice in a number of countries around the world but India still upholds a law established 147 years ago by the British colony which declares it a crime punishable by imprisonment. Ironically, the literature from India’s various religions supports homosexuality but it is considered a taboo practice by the democratic government and society. In addition, the law seems to be adding to the spread of HIV because gay men are afraid to be tested and then imprisoned. Combine this with an already poor STD protection status in India and HIV continues to spread rapidly throughout the population (Agoramoorthy & Minna).
Dressing modestly is an important part of the Indian culture, and healthcare workers must be aware of this when working with people of this culture.
Only the family should touch the body of someone who has just died.  If a healthcare worker needs to touch the patient, they should do it as little as possible, and especially avoid touching the head.   If possible, a family member should clean the body.

TOP 5 THINGS A NURSE SHOULD KNOW

  1. Hindu Indians believe in Karma, which is a belief that the actions of a past life affect the the circumstances in which someone is born in another life, so a patient might believe that their illness is caused by Karma.
  2. The bindi is a red dot worn by Hindu women on the forehead as a sign of honor and intelligence, but today it can be worn for decoration.  The nurse should be aware of the reason the woman is wearing the bindi.
  3. Meditation and prayer are important to Hindus, and some may meditate or pray aloud, or chant “om”.
  4. Vegetarianism is universal among devout Hindus, based on a belief in reincarnation.  It is based on the belief that the soul of a person enters back into creation as a living being.  Some pray a certain prayer before eating, asking forgiveness for eating a plant or vegetable in which a soul could dwell.
  5. Indian medicine is called Ayurveda which means “knowledge of life.”  This form of medicine mixes religion with secular medicine, focusing on the use of over 1400 plants and herbs.  Some Indians do not believe in the use of modern medicine or birth control.

Resources:

Abraham, L. (2002). Bhai-behen, true love, time pass: friendships and sexual partnerships among youth in an Indian metropolis. Culture, Health & Sexuality, 4(3), 337-353. Retrieved from CINAHL with Full Text database.

Agoramoorthy, G., & Minna, J.H. (2007). India’s homosexual discrimination and health consequences. Revista de Saude Publica, 41(4), Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89102007000400022&lng=en&nrm=iso&tlng=en doi: 10.1590/S0034-89102006005000036

Basu, A., & Dutta, M. (2007). Centralizing context and culture in the co-construction of health: localizing and vocalizing health meanings in rural India. Health Communication, 21(2), 187-196. Retrieved from CINAHL with Full Text database.

Bharadwaj, A. (2003). Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities. Social Science & Medicine, 56(9), 1867-1880. Retrieved from CINAHL with Full Text database.

Bhungalia, S.B., & Kemp, C.K. (2002). Cultural perspectives in healthcare: asian indian health beliefs and practices related to the end of life. Journal of Hospice and Palliative Nursing, 4(1), 54-58.

Singh, S.S, Bindloss, J.B., Bainbridge, J.B., & Brown, L.B. (2007). Lonely planet india. Melbourne, AU: Lonely Planet.

Wood, Michael. INDIA (2007). Woodlands Books Limited. Basic Books, New York, NY.

http://bearspace.baylor.edu/Charles_Kemp/www/indian_health.htm

http://www.kwintessential.co.uk/resources/global-etiquette/india-country-profile.html

http://www.britannica.com/EBchecked/topic/285248/India

http://www.nepalguides.com/Culture_and_Customs.html

http://www.iloveindia.com/indian-clothing/dhoti.html

http://www.newworldencyclopedia.org/entry/Sari#Types_of_Saris

http://censusindia.gov.in/Census_Data_2001/India_at_glance/religion.aspx

http://www.unicef.org/infobycountry/india_statistics.html

http://www.hawaii.edu/hivandaids/Asian_Culture_Brief__India.pdf

http://www.indianchild.com/caste_system_in_india.htm

http://www.anand.to/india/caste.html

http://www.culturalindia.net/weddings/wedding-rituals/index.html

http://www.boloji.com/women/02.htm

http://festivals.iloveindia.com/

http://indianfood.about.com/bio/Petrina-Verma-Sarkar-17036.htm

http://www. Indiasite.com

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